CHLOROQUINE-INDUCED PRURITUS IN MALARIA FEVER - CONTRIBUTION OF MALARIA PARASITEMIA AND THE EFFECTS OF PREDNISOLONE, NIACIN, AND THEIR COMBINATION, COMPARED WITH ANTIHISTAMINE
Ra. Adebayo et al., CHLOROQUINE-INDUCED PRURITUS IN MALARIA FEVER - CONTRIBUTION OF MALARIA PARASITEMIA AND THE EFFECTS OF PREDNISOLONE, NIACIN, AND THEIR COMBINATION, COMPARED WITH ANTIHISTAMINE, British journal of clinical pharmacology, 44(2), 1997, pp. 157-161
Aims Chloroquine treatment of malaria fever, results in a generalized
pruritus of unknown mechanism in up to 60% of adult Africans, by contr
ast pruritus is unusual in Caucasians following chloroquine use. Metho
ds We conducted a double-blind randomized, parallel group study to exa
mine and compare the antipruritic effects of promethazine, niacin, pre
dnisolone and their combination on pruritus induced by chloroquine, in
28 historical itching patients with parasitologically proven malaria
fever. We also evaluated the role of the antecedent malaria parasite d
ensity in the severity of chloroquine pruritus intensity; Results The
concurrent administration of chloroquine (2.1 g base total dose) with
prednisolone caused a statistically significant reduction in the pruri
tus AUC (0, 72 h) (P < 0.001 ANOVA) compared with the antihistamine pr
omethazine alone. The areas under the pruritus intensity-time curve we
re promethazine 105 +/- 28 (units h), niacin 76 +/- 22, prednisolone 2
8 +/- 24, and prednisolone and niacin 34 +/- 17 (P < 0.001 ANOVA). The
95% confidence interval for the difference in the pruritus AUC betwee
n prednisolone and promethazine was 8.4 to 145.6 units h. There was a
statistically significant and positive correlation between the pruritu
s intensity (AUC 0, 72 h) and the malaria parasite load in the itching
subjects, not receiving prednisolone (n = 9) (r = 0.73, P = 0.026 ANO
VA). Conclusion A single oral dose of prednisolone (10 mg) may be pref
erable to the antihistamine promethazine (25 mg) as an antipruritic ag
ent for concurrent prescription with chloroquine in individuals predis
posed to severe itching. Malaria parasite clearance and clinical ameli
oration were unaffected by any of the treatments.